Endocrine conditions Flashcards
What is the difference between primary and secondary hyperthyroidism?
Primary: pathology within the thyroid gland
Secondary: thyroid gland is stimulated by excessive thyroid stimulating hormone (TSH) in the circulation
What % of hyperthyroidism is graves disease
60-80% cases
What is the peak age onset of hyperthyroidism?
20-50
Who does hyperthyroidism effect the most?
women 9:1
Risk factors for Hyperthyroidism?
Family history High iodine intake Smoking trauma to thyroid gland toxic multinodular goitre childbirth HAART therapy
What symptoms does hyperthyroidism present with?
Weight loss despite an increased appetite Weight gain Increased/Decreased appetite Irritability Weakness and fatigue Diarrhoea/Steatorrhoea Sweating Tremor Mental illness Heat intolerance Loss of libido Oligomenorrhoea or amenorrhoea
What signs does hyperthyroidism present with?
palmar erythema sweaty and warm palms fine tremor Tachycardia (potentially AF or heart failure) Hair thining or diffuse alopecia Urticaria, pruritus Brisk reflexes Goitre Proximal myopathy Gynaecomastia Lid lag
What extra features are present in graves disease?
Eye changes- exopthalmos, opthalmoplegia, conjunctival oedema, papilloedema, keratopathy
Pretibial myxoedema
Thyroid acropachy
Thyroid bruit
Association with other autoimmune conditions
What is thyrotoxic storm/hyperthyroid crisis?
An uncommon medical emergency caused by an exacerbation of hyperthyroidism
What are the risks for thyrotoxic storm?
Infections
poor compliance
radio-iodine therapy
How does thyrotoxic storm present?
Fever >38.5 tachycardia delirium or coma seizures vomiting diarrhoea jaundice
How is thyrotoxic storm treated?
Correcting of thyroid hormones using high doses of propylthiouracil
fluid resuscitation
treat precipitating causes
What signs in hypethyroidism require urgent admission
Unwell/unable to manage at home
Presence of AF/cardiac failure
Dehydrated- eg from severe diarrhoea
Psychosis
What is the management for Hyperthyroidism
Start Carbimazole 3x daily
Consider starting a beta-blocker or calcium channel blocker to control symptoms driven by the sympathetic nervous system
Monitor TFTs monthly
Hyperthyroidism patient should be referred to a thyroid surgeon when..
there is symptoms of tracheal compression due to thyroid swelling There is swelling associated with: a solitary enlarging nodule previous neck irradiation family history of endocrine tumour hoarseness or voice changes neck glands young (before puberty)/old (>65) age
Name a drug associated with drug induced hyper/hypothyroidism
Amiodarone
What is the most common cause of hypothyroidism worldwide?
iodine deficiency
What is the incidence of hypothyroidism in men and women
Women 2%
Men 0.2%
Aetiology of primary hypothyroidism?
Autoimmune (Hashimotos thyroiditis) Iatrogenic Iodine deficiency Drugs (amiodarone) Congenital defects Infiltration of the thyroid (amyloidosis, sarcoidosis, haemochromatosis)
Aetiology of secondary hypothyroidism?
Isolated TSH deficiency
Hypopituitarism
Hypothalamic disorders
With what symptoms does hypothyroidism present?
Tiredeness, lethargy, intolerance to cold
Dry skin and hair loss
Slowing of intellectual activity
Constipation
Decreased appetite with increased weight gain
Deep hoarse voice
Menorrhagia and later oligomenorrhoea or amenhorroea
impaired hearing
Reduced libido
With what signs does hypothyroidism present?
Dry, coarse skin, hair loss and cold peripheries
Puffy face, hands and feet (myxoedema)
Bradycardia
Delayed tendon reflex relaxation
Carpal tunnel syndrome
Serous cavity effusions, eg. pericarditis or pleural effusions
5% will have opthalmopathy as in Graves
How does myxoedema present?
Expressionless dull face with peri-orbital puffiness, swollen tongue, sparse hair
Pale, cool skin with rough, doughy texture
Enlarged heart
Mega-colon/intestinal obstruction
cerebellar ataxia
Psychosis
Encephalopathy
How common is postpartum thyroiditis?
occurs in 5-7% of pregnancies within the first 6 months postpartum. Most women show complete remisission
